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Abstract Background Despite recommendations by Health Authorities, influenza immunization coverage remains low in children with chronic diseases. Different medical providers involved in the management of children with chronic conditions may affect the pattern of influenza vaccine recommendations and coverage. The likelihood of vaccination by type of provider in children with chronic conditions is poorly understood. Therefore, the objectives of this study were to analyze the pattern and the effect of recommendations for seasonal influenza immunization provided by different physician profiles to families of children with chronic diseases and to measure the frequency of immunization in the study population. Methods We recruited children with chronic diseases aged 6 months–18 years who subsequently presented to specialty clinics for routine follow-up visits, during spring 2009, in three Italian Regions Families of children with chronic diseases were interviewed during routine visits at reference centers through a face-to-face interview. We analyzed the following immunization predictors: having received a recommendation toward influenza immunization by a health provider; child’s sex and age; mothers and fathers’ age; parental education and employment; underlying child’s disease; number of contacts with health providers in the previous year. Influenza immunization coverage was calculated as the proportion of children who received at least one dose of seasonal influenza vaccine in the previous season. We calculated prevalence ratios and we used a generalized linear model with Poisson family, log link and robust error variance to assess the effect of socio-demographic variables, underlying diseases, and recommendations provided by physicians on influenza immunization. Results We enrolled 275 families of children with chronic diseases. Overall influenza coverage was 57.5%, with a low of 25% in children with neurological diseases and a high of 91.2% in those with cystic fibrosis. While 10.6% of children who did not receive any recommendation toward influenza immunization were immunized, among those who received a recommendation 87.5-94.7% did, depending on the health professional providing the recommendation. Receiving a recommendation by any provider is a strong predictor of immunization (PR = 8.5 95% CI 4.6;15.6) Most children received an immunization recommendation by a specialty (25.8%) or a family pediatrician (23.3%) and were immunized by a family pediatrician (58.7%) or a community vaccinator (55.2%). Conclusions Receiving a specific recommendation by a physician is a strong determinant of being immunized against seasonal influenza in children with chronic diseases independently of other factors. Heterogeneity exists among children with different chronic diseases regarding influenza recommendation despite international guidelines. Increasing the frequency of appropriate recommendations toward influenza immunization by physicians is a single powerful intervention that may increase coverage in children with chronic conditions.

Background: Dealing with complex chronic disease may take great advantage of mobile health (m-health) technologies. We performed an online survey on the perception of use of m-health technologies among families of patients affected with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome., Materials and Methods: The survey included questions on sociodemographic characteristics, availability of a connection to the Internet on different devices, interest in m-health technologies, and functions to be implemented in order to meet family needs. Through multivariate analysis we studied the association between characteristics of enrolled families and interest in m-health., Results: In total, 166 people completed the questionnaire. Forty-seven percent connected to the Internet through a mobile phone, versus 34% through a tablet. Eighty percent were interested in m-health solutions for their child's disease; the main reasons of interest were saving time (49%) and being more involved in the disease management (49%). Desired m-health services were aimed at rapid consultation with a physician (68%) and at retrieving updated information on research and on ongoing clinical studies (66%). Interest in m-health services was associated with availability of a mobile Internet connection, whereas no association was found with living in a remote area., Conclusions: Families of patients with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome show a positive attitude toward m-health technologies. Such syndromes represent a good model for translating published recommendations into m-health applications, which may improve compliance. Expectations regarding m-health lead to patient empowerment, and m-health applications are perceived as useful not only for people living far away from healthcare centers.

Despite widespread recommendations, vaccination coverage in high-risk groups is generally low. Various interventions have shown to be effective in improving immunization rates, especially in the healthy population. In this paper, we present a project supported by the Italian Centre for Disease Control, whose aim is to study determinants of vaccine administration to children with chronic diseases and to study the effect of experimental multilevel interventions to increase vaccination coverage in these patients.